The 2008 National Institute of Child Health and Human Development (NICHD) Workshop
Report on Fetal Heart Rate (FHR) Monitoring
1
states that, “moderate FHR variability reliably predicts the absence of fetal metabolic
acidemia at the time it is observed.”
1
This cannot remain unquestioned in the face of contradictory evidence. Two recent
studies report at least 78 cases of neonatal acidemia despite moderate variability.
2
,
3
Cahill et al. identified 57 infants with acidemia (defined as pH ≤7.10 on umbilical
artery cord gas) out of a series of 5388 consecutive singleton, non-anomalous, cephalic
pregnancies who reached the second stage.
2
Of those 57 infants with acidemia, over 90% (52 of the 57 patients) had moderate
variability.
2
Clark et al. found that in a series of 120 infants with metabolic acidemia (defined
as base deficit >12) at birth, that at least 18% (21 cases) had moderate variability.
3
Clark et al. write that their findings challenge “decades-old assumptions regarding…
the importance of variability in excluding metabolic acidemia.”
3
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References
- The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines.Obstet Gynecol. 2008; 112: 661-666
- Association and prediction of neonatal academia.Am J Obstet Gynecol. 2012; 207 (e1-8): 206
- The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia.Am J Obstet Gynecol. 2017; 216: 163.e1-163.e6
- Diagnostic accuracy of fetal heart rate monitoring in the identification of neonatal encephalopathy.Obstet Gynecol. 2014; 124: 507-513
- Deceleration area and fetal acidemia.J Matern Fetal Neonatal Med. 2017; 30: 2578-2584
Article info
Publication history
Published online: December 21, 2017
Accepted:
October 1,
2017
Received:
June 3,
2017
Footnotes
Competing interests: None declared.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
